The symptoms you might not expect
When most women think about perimenopause, they think of hot flashes, night sweats and irregular periods. But often, those aren’t the symptoms that first bring women into my office.
Instead, I hear things like:
“I just don’t feel like myself.”
“I’ve never been anxious before, but suddenly everything feels overwhelming.”
“I’m exhausted, but I’m waking up at 3 a.m. every night.”
“Why am I forgetting everything?”
And one of the most common: “My periods are still regular, so it can’t be perimenopause… right?”
Actually, it can.
Perimenopause can start while you’re still having regular periods
Perimenopause is the transition leading up to menopause, when estrogen and progesterone begin to fluctuate more significantly. It most commonly begins in your 40s, although every woman is different.
Menopause itself isn’t reached until you’ve gone 12 consecutive months without a period. The years leading up to that are perimenopause — and symptoms can start well before your period disappears.
Some of the symptoms women don’t always associate with perimenopause include:
Sleep changes: Trouble falling asleep, waking throughout the night or the classic 3 a.m. wake-up.
Brain fog: Forgetfulness, difficulty concentrating or struggling to find the right word.
Mood changes: New or worsening anxiety, irritability, feeling more emotional or simply having a much shorter fuse.
Cycle changes: Periods becoming shorter, longer, heavier, lighter or less predictable.
Joint and muscle aches: Feeling more stiff or achy without an obvious reason.
Body composition changes: Noticing more weight around the abdomen or feeling like the things that previously worked for your body aren’t working quite the same anymore.
Vaginal and sexual changes: Dryness, discomfort with intercourse, changes in libido or new urinary symptoms.
And, of course, hot flashes and night sweats can happen too!
Is it hormones — or something else?
With perimenopause everywhere on social media right now, it’s easy to blame every new symptom after 40 on hormones. But not everything is perimenopause.
Fatigue, anxiety, sleep changes, hair changes, weight changes and brain fog can also be related to thyroid disorders, iron deficiency, sleep disorders, medications and other health concerns.
This is also why I don’t rely on one hormone test to tell someone whether they’re in perimenopause. Hormones can fluctuate significantly during this stage, so a single blood test only gives us a snapshot in time.
Instead, we look at the whole picture — your age, menstrual cycle, symptoms, health history and, when appropriate, lab work to rule out other causes.
You don’t have to just “deal with it”
There are so many more options available to women going through perimenopause and menopause than we used to talk about.
Nutrition, exercise, sleep, stress management, supplements, non-hormonal treatments and menopausal hormone therapy can all have a place depending on the woman, her symptoms and her health history.
This is where a naturopathic doctor can cut through the confusion.
